MEDICARE: ASHLEY WALTERS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP125860	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104231513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY WALTERS NP

Provider Business Mailing Address
First Line	:	2501 JIMMY JOHNSON BLVD STE 405
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-2013
Country	:	US
Telephone Number	:	409-727-4422
Fax Number	:	855-510-6580

Provider Business Practice Location Address
First Line	:	2501 JIMMY JOHNSON BLVD STE 405
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-2013
Country	:	US
Telephone Number	:	409-727-4422
Fax Number	:	855-510-6580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	09/26/2024

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